Coronavirus (COVID-19) Medication Advice for Rheumatology Patients

If you have Rheumatoid Arthritis, Psoriatic Arthritis or Ankylosing Spondylitis and are on biologic drugs (including Baricitinib and Tofacitinib)

1. You should stop these drugs immediately if you develop any fever (feeling shivery), sore throat or cough
2. It the outbreak spreads you may be advised to stop treatment even if you are well
3. Methotrexate and Leflunomide should only be stopped if you are unwell with a fever. You will need special treatment to remove Leflunomide from your body if you are unwell enough to need to come to hospital.

If you have Lupus (SLE) and are on Azathioprine or Mycophenolate it is important not to stop these unless you are clearly unwell (have fever) and have been advised to do so by a medical professional. Please contact us.

Sulphasalazine and Hydroxychloroquine are not immunosuppressant drugs and can be continued even if you are unwell.

For all patients we believe NSAIDs (Ibuprofen, Naproxen, Etoricoxib) can make COVID-19 infection worse. Therefore if you are unwell you should try and stop these drugs but you do not need to stop them is you are well.

Rheumatology

We deal with the diagnosis and management of acute and chronic inflammatory conditions. We also deal with neck/back pain, soft tissue problems and shoulder disorders, although initial referral for management of these conditions is usually to the Locomotor Service.

Other conditions that we manage include osteoarthritis, gout, bone disorders such as osteoporosis, osteomalacia and Paget’s disease.

Treatments are mainly based in the outpatients department and on the medical day unit. We work closely with physiotherapists and occupational therapists within the hospital and the Primary Care Trust.

Most conditions are assessed in the rheumatology outpatient clinics. In clinic, patients have the opportunity to discuss other coping strategies to improve their health including exercise and alternative therapies, hydrotherapy, occupational therapy and podiatry.

The need for social service intervention is also discussed and if necessary an immediate referral to the appropriate health professional is made.

Appointments

For straightforward neck/back/shoulder/other soft tissue problems, initial referral via the City and Hackney Locomotor service is suggested. Patients will be referred on to us if thought appropriate at triage by the Locomotor Service or following assessment/treatment if necessary.

specialist clinics

General Rheumatology clinic: These clinics are for patients who have inflammatory or degenerative arthritis and other musculoskeletal conditions, including neck/back pain, and soft tissue problems

Early Arthritis clinic: This clinic is for patients with less than one year’s history of symptoms of inflammatory arthritis. This is a rapid access clinic and we aim to see patients within two weeks of referral. Referrals can be made via e-RS and all referrals will be triaged by a Consultant Rheumatologist and placed in an appropriate slot. Please note that on e-RS it may appear that no urgent/early slots are available: however, if the referral is deemed appropriate for the Early Arthritis Clinic, following triage it will be brought forward to an urgent slot to be seen as soon as possible.

Biologics clinic: This is for patients who may benefit from or are receiving therapy with anti-TNF drugs or other biologic agents when treatment with traditional disease modifying drugs is ineffective or insufficient to achieve adequate disease control in conditions such as rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis.

Combined foot clinic: These clinics take place with the podiatric surgeons and take place every three months for people with conditions specific to their feet

Patient education and drug monitoring clinic: This involves physical assessment and ongoing education by the Rheumatology Specialist Nurses to ensure patients understand their disease, medication and reasons for blood tests

Methotrexate injection clinic: This is held in the outpatients department twice a week for the administration of subcutaneous methotrexate.

Infliximab, Rituximab, Tocilizumab and Abatacept infusions are administered intravenously on the medical day unit. Each patient must allow up to four hours stay in hospital for the treatment, close observation of their vital signs, joint assessment and have a blood test before being discharged.